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TRANSCRIPT
Achieving Strategic
Results
December 14, 2011
Pete Knox Executive Vice President
Chief Learning & Innovation Officer Bellin Health
Overview of the Presentation
1. Bellin Health
2. Where are we today
3. Why is it so hard
4. What can we do
2
Bellin Health - Mission Statement
Bellin Health is a community-owned not-for-profit organization
responsible for the physical and emotional health of people living in
Northeast Wisconsin and the Upper Peninsula of Michigan.
Directly, and in partnership with communities, employers, schools, and
government officials, we guide individuals and families in their lifelong
journey toward optimal health. We are committed to providing safe,
reliable, cost-effective total health solutions with respect and
compassion. Our innovative work will impact healthcare delivery in our
region, as well as throughout the world.
3
Vision Statement
The people in our region will
be the healthiest in the nation.
4
Strategic Objectives
Objective 1: Patient, Family & Customer-Centered
Organization
Objective 2: Engaged Staff and Partners
Objective 3: Improved Health of the Population
Objective 4: Growth & Prosperity
5
Bellin Health Overview Serving a market of 600,000 people
• Bellin Hospital, a 220-bed community hospital with proven
excellence in heart and vascular care; orthopedics and
sports medicine; family programs and services; and
minimally invasive procedures including robotic surgery
• Oconto Hospital & Medical Center, a critical-access
hospital in Oconto
• Bellin Medical Group, a 93-member primary care group
with 34 clinic sites and proven excellence in disease
management and wellness care
• Physician Partners, Ltd, more than 170 independent
specialty physicians
• NorthReach, a 26-member primary care group managed in
partnership with Bay Area Medical Center in Marinette
• Bellin Orthopedic Surgery Center, an ambulatory
orthopedic surgery center merged in partnership with a local
orthopedic physician practice
• Bellin Psychiatric Center, a dominant provider of in- and
outpatient behavioral health services
• Bellin College with baccalaureate and masters degree
programs to educate and train nurses and radiologic
technologists
• Unity Hospice, providing hospice and palliative care
services 6
Volumes and Cost
-8.0%
-6.0%
-4.0%
-2.0%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
2003 2004 2005 2006 2007 2008 2009 2010
Bellin Health
Growth compared to Cost
Adjusted Patient Days Cost to Produce
7
Cost
Source: Dartmouth Atlas
8
Source: www.IHI.org. The Hospital Standardized Mortality Ratio (HSMR) is provided to the Institute of Health
Care Improvement (IHI) by Professor Sir Brian Jarman, Imperial College, London, and Dr. Foster.
Mortality Rate
9
Source: The Hospital Care Quality Information from the Consumer Perspective survey data is taken from
the CMS Hospital Compare web site (www.hospitalcompare.hhs.gov).
Patient Satisfaction
10
Primary Care Quality and Cost
Primary Care Cost and Quality (10/09-9/10)
0%
10%
20%
30%
40%
50%
60%
High Cost, Low
Quality
Low Cost, Low
Quality
High Cost, High
Quality
Low Cost, High
Quality
% o
f A
ffilia
tio
n P
rovid
ers
Aurora Bellin PreveaData reported from Wisconsin Health Information Organization
11
Competitor #1 Bellin Competitor #2
Bellin Health
Payer Mix compared to Operating Performance
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
2006 2007 2008 2009 2010 2011
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
Medicare Medicaid Operating Margin
Quality Matters
12
13
Health Care At A Crossroads
A great chasm to cross but many not
capable of making the journey.
The Current Situation
• Pressuring mounting . . . for something
• Positioning of many for something different
• Many “waiting to see”
• Trouble brewing
14
The Chasm to Cross
What is on the Minds of Senior Leaders
1. How will I prioritize the various cost and quality imperatives my organization
will need to accomplish to thrive?
2. How will I reach beyond the walls of my organization. To public health
authorities, non profit groups and others, and engage these key community
partners in helping to improve the health of patient population my
organization serves.
3. How will I move my organization toward true clinician alignment and
integrated care delivery?
4. What does “accountable care” mean for my organization? Are market
reform forces moving toward population health broadly, or should we focus
on creating integrated care models for certain populations?
5. How will I effectively lead my organization through the transition from volume
based payment model we operate under now to the value based payment
model that is coming?
Huron Healthcare Report
15
Healthcare at a
Crossroads
Low
Risk
The need for a comprehensive strategy to
navigate the corridor.
High
Risk
Low Coordination
High Coordination
TODAY
FUTURE
REIMBURSEMENT
-$
-$
$$
Hig
h
Capabilities to Make the Journey
Obstacles to Executing Strategy
Low High
Resistance to
change
Silos or
units with
competing
agendas
Lack of clear & decisive
leadership; actions
inconsistent with strategy
Everyone too busy;
lack of time; resource
constraints
Too focused on short-term results
Lack of accountability or follow-
through; inability to measure impact
Poor communication of
strategy Making it meaningful to
frontline; translating
strategy to execution;
aligning jobs to strategy
POPULARITY OF RESPONSE
70% FAILURE RATE
IMP
OR
TA
NC
E O
F O
BS
TA
CLE
17
The Path Forward
Building organizations
that are capable of
aligning, deploying and
executing strategy.
18
Assessment Strategic Clarity & Production System Design
STRATEGIC CLARITY
High level specifications for the production system defined 1 2 3 4 5
Clear aims (1-5 years) cascaded to organization 1 2 3 4 5
Clear value proposition for customers 1 2 3 4 5
Organizational energy alignment 1 2 3 4 5
Organization wide clarity on strategic intent and direction 1 2 3 4 5
PRODUCTION SYSTEM DESIGN
Individual plan 1 2 3 4 5
Unit / team 1 2 3 4 5
Product across the continuum plan 1 2 3 4 5
Functional / operational area plan 1 2 3 4 5
Large scale commonality plan 1 2 3 4 5
TOTAL
Not Fully Developed Developed
19
Assessment Measurement System & Performance Improvement Design
MEASUREMENT SYSTEM DESIGN
Large scale commonality measurement system 1 2 3 4 5
Product across the continuum measurement system 1 2 3 4 5
Functional / operational measurement system 1 2 3 4 5
Unit / team measurement system 1 2 3 4 5
Individual measurement system 1 2 3 4 5
PERFORMANCE IMPROVEMENT DESIGN
Managing quality control 1 2 3 4 5
Driving innovation 1 2 3 4 5
Rhythm and discipline 1 2 3 4 5
Consistent and standardized methods & tools 1 2 3 4 5
Managing to the “Sweet Spot” – Maximizing organization
energy
1 2 3 4 5
TOTAL
Not Fully Developed Developed
20
Assessment Marketing/Sales Alignment & Cultural Alignment
MARKETING/SALES ALIGNMENT
Leveraging production system capabilities 1 2 3 4 5
Targeted at “Permission to Believe” 1 2 3 4 5
Customer relationships 1 2 3 4 5
Positioning brand in market 1 2 3 4 5
Measuring ROI 1 2 3 4 5
CULTURAL ALIGNMENT
Organizational health platform development 1 2 3 4 5
Organizational performance platform development 1 2 3 4 5
Alignment of internal/external partners 1 2 3 4 5
Measuring ROI 1 2 3 4 5
Culture aligned with Mission 1 2 3 4 5
TOTAL
Not Fully Developed Developed
21
What Features/
Functions Should
Our Products Have?
What Should
We Make?
How Will We
Make It?
What Do We Need
to Improve/
Redesign?
Do People Buy Our
Products?
Products and
Services
SYSTEM OF
PRODUCTION
SYSTEM OF
MEASUREMENT
Is It Made Well?
SYSTEM OF
IMPROVEMENT
SALES
MARKETING
- Market/Customer Knowledge
- Organizational Knowledge
ORGANIZATIONAL
STRUCTURE
ALIGNMENT AND
DEPLOYMENT
ROAD MAP
BRANDS
Strategic Position
SYSTEM OF
LINKED MEASURE
Focus
Platform
Knowledge
Action
Results OFFERED / CHOSEN
“VOICE OF THE MARKETPLACE”
External Focus
“VOICE OF THE CUSTOMERS”
External Focus
High Performance Health Care Model
The Business of Health Care
©Knox 2000
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“VOICE OF THE PROCESS”
Internal Focus
1
2
3
4
5 6
22
The
Strategic
Dimension
1
23
2015
The Role of Strategic Clarity
Value Proposition to Customers
Clear Aims Cascaded to Organization 1 - 3 - 5 yr
High Level Specifications for Production System
Aligning Energy
Nurturing the Organization
VISIONS AND TARGETS
1
24
Process for Strategy Alignment 1
Strategy
Research &
Education
Scenario
Planning
Planning to
Close the Gap
Establish
Portfolio of
Projects
Execution
Benchmarking
Modeling
25
The
“LIVING”
Cycle of Aligning
And Deploying
Strategy
Strategic Alignment and Deployment
AIMS 1-3-5 yr
Portfolio of Projects
SYSTEM
Cascading of Aims and Improvement
BRAND
DEPARTMENT
INDIVIDUAL
AIMS 1-3-5 yr
AIMS 1-3-5 yr
AIMS 1-3-5 yr
Portfolio of Projects
Portfolio of Projects
Portfolio of Projects
MISSON / VISION
Strategies
Strategies
Strategies
Strategies
Strategic Results
26
1
Proposed Scorecard
Population Health 2012 PROPOSED SCORECARD POULATION HEALTH 2012
BELLIN HEALTH
Risk Adjusted Mortality 1.31
.99 2012
.95 2014
.90 2016 Ed M Established Per Statit definition
BMG Panel Health Index N/A
100% top 3 2012
100% top 1 or 2
2013 TBD 2014
and beyond Amy D
Establish
Baseline
% ranking WCHQ database
Numerator: # rankings at target
Denominator: Number of rankings
BMH core Measures Index 93.5
95% 2012
91% 2014*
99% 2016* Andrea W Established
Per Statit definition
*Because Core Measures change,
re-adjustment will be likely
Days Between Serious
Patient Events 189
60d 2012
Prev. Harm 2013+ Laura H Established
Per Statit 2012
+New metric on preventable harm
for 2013
Employer HRA Scores
Overall 75.2
75.7 2012
76.7 2014
77.7 2016 Randy V Established
Per Statit definition
Improve .5 per year
Community Population
Health Measure N/A TBD Jacquelyn H TBD
Operational Definition 2012
Metrics and targets 2013 and
beyond
Measure of a Connected
Experience N/A TBD Jacquelyn H
In
Development
Operational Definition 2012
Metrics and targets 2013 and
beyond
1
27
The Role of the
Production System
Design and deliver to specifications
2
28
Platform Planning
Collection of assets that are shared by
a set of products:
• Components
• Processes
• Knowledge
• People and relationships
Robertson/Ulrich
2
29
Three Information Management Tools
The Product Plan
The Differentiation Plan
The Commonality Plan
Robertson/Ulrich
2
30
Balancing Commonality
and Distinctiveness
• Customers care about distinctiveness; costs are driven by commonality.
• Closely meeting the needs of different market segments requires distinctive products.
• At the same time, the cost of a firm’s internal operations is largely driven by the level of parts held in common among a collection of products and is not directly related to how distinctive those products are in the marketplace. Sloan Management Review Summer 1998
2
31
Anatomy of the
Production System
Five views of the Production System
1. Individual contributor
2. Unit / team
3. Product across the continuum
4. Functional / operational area
5. Large scale commonality
2
32
33
Knowledge
of the
Individual
Connected Personal Experience Individual
health &
life goals
The Production System 2
$ Q
H
33
Knowledge
of the
Individual
Collective Personal Experience Individual
Health &
Life Goals
1
*
Individual Contributor
34
* * * * * * *
$ Q
H
The Production System 2
Knowledge
of the
Individual
Collective Personal Experience Individual
Health &
Life Goals
2 Unit / Team
35
$ Q
H
PCP EMS ED 4Med OT/PT SNF PCP Neuro Rehab
The Production System 2
Product Across the Continuum
Stroke Management
Knowledge
of the
Individual
Collective Patient Experience
PCP EMS ED 4Med OT/PT SNF PCP Neuro Rehab
Individual
health &
life goals
3
$ Q
H
The Production System 2
36
Knowledge
of the
Individual
Collective Personal Experience Individual
Health &
Life Goals
$ Q
H
4
IT
Nursing
Functional & Operational Areas
37
The Production System 2
Knowledge
of the
Individual
Collective Personal Experience Individual
Health &
Life Goals
5
Wellness/
Prevention
Acute
Care
After
Care
Community
Health
Large Scale Commonality
38
$ Q
H
The Production System 2
Knowledge
of the
Individual
Collective Personal Experience Individual
Health &
Life Goals
Five Views of the
Production System
3 Product
Continuum 2 4
Nursing
5
1
*
Wellness/
Prevention
After
Care
Community
Health
39
2
The Role of the
Measurement System
Inform and Provide Knowledge
3
40
Knowledge
of the
Individual
Collective Personal Experience Individual
Health &
Life Goals
Measurement System for the
Production System
3 Product
Continuum 2 4
Nursing
5
1
*
Wellness/
Prevention
After
Care
Community
Health
41
3
Aligning Production & Measurement 3
View Measure Owner
Individual Individual
Unit Team Lead
Product Service Line Leader
Functional Area Chief and/or VP
Commonality ?
42
System
of
Improvement
4
43
Managing Organizational Energy
• Lots of activity
• Few results
4
• Fully utilized capacity
• Many results
• Low activity
• Few results
• Empty capacity
• Limited/mixed results
Fully Utilized
Non
Aligned Aligned
Under Utilized
The Sweet Spot of
organizational energy
44
Current Processes
Reliable/Predictable/Safe
Innovation
“Pool of Ideas”
Priority Gate Spread Gate
Strategy
Aims
Improvement
Priorities
Strategy
Results
CURRENT
Performance
NEW
Performance
4 Managing Organizational Energy
45
Market / Sales
Alignment
5
46
•We know that a cancer diagnosis can be overwhelming and with it
can come a host of concerns and decisions that have to be made.
For most people there is an immediate need for information and a
desire to be “doing something”. We want to help you make sure the
information you’re getting is accurate and helpful so that you can
move through each step of the decision-making process in control
and on your teams.
This isn’t about rushing . . . It’s about responding.
There is nothing more frightening than being told you have cancer.
Unless it’s being told you have cancer and then being told nothing at
all for days. . . Even weeks. At The Cancer Team, we’re committed
to treating you with dignity and respect by first making sure that you
aren’t left alone with your fears. From the beginning, The Cancer
Team member will work together to respond and include you in the
process of developing a treatment plan.
5
47
Cultural
Alignment
6
48
Performance Platforms Leadership Development
Professional/Personal Development
Environment / Culture
Talent Management
Reward / Recognition
Strategic Execution
Knowledge Management
Innovation
Diffusion and Spread
Learning System
HEALTH
Performance
Results
Mission
Strategy Vision
6
49
Building a More Capable Organization
1. Identify areas for development
2. Identify team to assess and build plan for each dimension
3. Develop longer term aims for each dimension
4. Develop short term (120 days) action plan to close the gap
5. Provide reports and feedback to the organization
6.Develop a Steering Team
50
IHI
SITE VISIT
51